The interaction and tensions between traditional Chinese medicine and Western medicine : biomedical ontologies and epistemic authority in New Zealand : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Sociology at Massey University, Albany, New Zealand
In 2010, traditional Chinese medical groups put forward an application to become a regulated profession in New Zealand, sparking debates over the place of traditional Chinese medicine (TCM) in New Zealand’s healthcare sector. This thesis examines this debate over regulation as a lens through which to understand the epistemic tensions between biomedicine and TCM, and the challenges TCM practitioners face in their practice in New Zealand. Theoretically, I draw on Neo-Weberian frameworks of social closure and Bourdieu’s framework of symbolic violence to examine the material and symbolic forms of social closure that western medicine utilises to create boundaries between western and TCM. I carried out semi-structured interviews with five TCM practitioners in Auckland, New Zealand and analysed these interviews to elucidate the ways that TCM practitioners understand and navigate the challenges of practicing in New Zealand. I also carried out an extensive document analysis of all thirty-five submissions made to the Ministry of Health regarding TCM’s application for regulation under the Health Practitioners Competence Assurance Act of 2003 (HPCA Act). My document analysis found that western medicine maintains dominance in New Zealand’s medical sphere through material and symbolic forms of social closure. All forms of social closure are underpinned by the public safety discourse associated with positivist frameworks of medicine; however, the symbolic forms of social closure also illustrate the ethnocentric prejudice working against TCM. The western medical sector has questioned whether TCM fits the safety and efficacy criteria of evidence-based medicine, which depend on randomised control trials to establish whether medical treatments are safe and effective. This public safety discourse aligns with positivist epistemologies of health and has largely worked against TCM. Positivist methodology has been deemed as the “gold standard” which has undermined TCM practice, with western practitioners questioning the safety, efficacy, and in turn the legitimacy of TCM. These forms of social closure impose Eurocentric standards of practice on TCM that have created numerous challenges for TCM practitioners in their daily practice. My interviews with TCM practitioners revealed the different ways practitioners navigate the challenges of working in a biomedical society. While tensions between western and TCM are evidenced in the divergent epistemologies of health, tensions have also emerged within the Chinese medical community as younger and older generation practitioners navigate the challenges they face as a consequence of the various forms of social closure enacted upon them. These tensions are exacerbated due to the different understandings younger and older TCM practitioners have around TCM’s place in New Zealand society and the precariousness of modernity. I conclude that while regulation is unlikely to resolve the epistemic tensions between western and TCM, it is a step toward overcoming the epistemic hierarchy and the subsequent challenges that stem from New Zealand’s medical hierarchy. As regulatory discussions are ongoing, this research is timely and could assist in policy discussions by highlighting the different challenges and perspectives of TCM practitioners, particularly given that the hegemony of western medicine and its positivist rhetoric that has largely undermined TCM’s legitimacy and the voices of TCM practitioners. While regulation is often seen as a way to manage both systems, existing regulatory systems have catered to the management of western medical practice, not TCM. Thus, incorporating TCM into mainstream healthcare frameworks may not necessarily lead to a more pluralistic healthcare system and needs to be carefully considered; particularly due to the different opinions from both western and TCM practitioners around what is best for TCM moving forward in New Zealand.